Ways to prevent heart disease

Heart disease statistics may be on the decline but it remains the biggest killer worldwide, claiming more female lives than all forms of cancers combined. This might have something to do with a burgeoning obesity epidemic and it is childhood obesity, spiralling out of control, that is making us struggle to get on top of an eminently preventable disease.

While it is LDL — the so-called bad cholesterol — that initiates the process leading to the blockage of our blood vessels, inflammatory cells pouring into the vicinity of already bloated LDL molecules are the promoters, aggressively driving the machinery that makes us vulnerable to fatal heart attacks.

What is so concerning about this toxic stew is that, once inflammatory cells (which are servants of the immune system that have become overheated) start to swarm around LDL, this combination becomes so powerful and the march so relentless that reversing atherosclerosis — the progressive occlusion of our arteries — becomes increasingly difficult.

The more fat we have, the more inflammatory cells we make, and if we commence churning these out in childhood we have a ready supply of harmful chemicals contributing to establishing a disease that hovers menacingly over our survival prospects in adulthood. The battle lines are then drawn to hose down and combat a raging inferno that might have been circumvented before the first flame was ignited.

Alarming reports are emerging of infants who are fed diets high in calories, develop obesity and then demonstrate evidence of atherosclerosis that is present by 24 months of age. Research now indicates that obese children have disorders such as high blood pressure and diabetes, which are typical of adulthood, and as a consequence have all the signs of premature vascular ageing we would only expect to find in a much older cohort.

Obese mothers have a higher risk of giving birth to offspring who have greater odds of becoming obese, which means prevention needs to start by first getting mothers to lose weight. Evidence even points to the fact that we need to resort to weight-loss-generating bariatric surgery to deal with the obesity plague rife among child-bearing women.

Fat cells aren’t the only source of fiery inflammatory molecules. Other prime generators of inflammation include germs that emanate from guts and lung infections; pollution; passive exposure to cigarette smoke; homocysteine, a protein that is usually harmlessly recycled if we have sufficient B vitamins; and autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and psoriasis.

HDL, the good cholesterol, has always been a molecule on which we could rely to unblock our blood vessels. When it does its job, it very efficiently removes cholesterol from LDL and transports it to the liver, where it is summarily jettisoned. HDL also has anti-inflammatory and antioxidant capacities, which means it has an array of talents protecting us against the development of heart disease. At least, this has been the case up till now.

Recent research has revealed that inflammation has become so overpowering that it has rendered HDL dysfunctional, causing this traditionally heroic chemical to morph from Superman into Clark Kent. The latest evidence shows that, once heart disease sets in, raising HDL is no longer effective in reducing the risk of succumbing to a heart attack. Even in healthy people, who don’t have established atherosclerosis, HDL may no longer be the panacea it once was.

B3 or not B3?

This might explain why niacin, or vitamin B3, the go-to nutrient when it comes to substantially raising HDL and preventing heart disease, has been receiving conflicting media coverage when reviewing its potential to protect us against the progression of this disorder. This is a distressing development as niacin was the only nutrient with any science that supported its heart-healthy benefits.

In fact, while embracing statins — the omnipotent cholesterol- and LDL-lowering medications that some heart specialists would like to see placed in our drinking water — has led to significant reductions in heart disease, a sizeable number of those who take these medications haven’t been the beneficiaries of their largesse. This has led to niacin stepping up as a possible alternative.

Aside from augmenting HDL, niacin also has the ability to lower cholesterol, LDL and triglycerides — another fat that signals the blockage of arteries — and to reduce inflammation. In mice it can reverse atherosclerosis and open up blood vessels without elevating HDL, indicating it can be impactful way beyond its effect on the cholesterol profile. In a head-to-head analysis examining a number of clinical trials, niacin actually fares far better than statins when it comes to preventing heart disease. It is against this glowing backdrop that two bits of evidence just released cast a shadow over niacin’s lustre.

In one trial, niacin was added to statins in those who already had heart disease to see if this partnership would confer any added advantage. This experiment had to be aborted ahead of the anticipated completion date due to an increased incidence of strokes in those receiving niacin. Similar research in which niacin was added to cholesterol-lowering medications uncorked a number of side-effects, including skin rashes, elevations in blood glucose and unpredicted effects such as an increased incidence of infections and bleeding in the gut.

Another twist to the niacin saga is that it forms part of a complex molecule that increases breast cancer risk in post-menopausal women who are obese. The molecule nicotinamide phosphoribosyltransferase (Nampt) is produced in the fat around internal organs. Aside from breast cancer risk, the incidence of prostate and colon cancers also goes up as Nampt levels rise. Nampt seems to stimulate the growth of these cancers and encourages them to spread. It is feasible, although not yet explored, that supplementary niacin would boost Nampt and the evolution of cancers. Neutralising Nampt would be one way to stop cancers in their tracks and curcumin is one natural agent that does exactly that.

With all this conflicting evidence we may have to return to the cause of inflammation and the early genesis of heart disease, which is all about the way we feed our children.

Dr Michael Elstein is a Sydney-based anti-ageing physician and writer. He is the author of two books, Eternal Health: The Comprehensive Guide to Anti-Ageing for the New Millennium and You Have the Power: Why didn’t my doctor tell me about this?